Individual provider Active NPI

Carol Allicia Ann Maxwell, APRN

  • Family Nurse Practitioner
  • Virginia Beach, VA
National Provider Identifier
1134538168
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024182777 Issued in VA
Practice address
1035 Nider Blvd Ste 100
Virginia Beach, VA 23459-8701
Phone
(757) 953-8351
NPI assigned
Aug 4, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024182777 VA Primary

Addresses

Primary practice location

1035 Nider Blvd Ste 100
Virginia Beach, VA 23459-8701

Mailing address

620 John Paul Jones Cir
Portsmouth, VA 23708-2111

Other identifiers 1

IdentifierTypeStateIssuer
7100348230 (KOHMG)MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191206000830 TX Practitioner - Nurse Practitioner 0941523138 Reassigns benefits to 1 organization
I20230720004176 VA Practitioner - Nurse Practitioner 0941523138 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024182777VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thoreau Clinic CurrentSince Oct 15, 2019 Accepting new patients
Neurosurgical Associates PSC Current Accepting new patients
Privia Medical Group, LLC CurrentSince Jun 6, 2023 Accepting new patients
DHHS PHS Naihs Crownpoint Hospital Current Accepting new patients
Pueblo Pintado Clinic Current Accepting new patients
Privia Medical Group, LLC CurrentSince Jun 6, 2023 Accepting new patients
Komg-Louisville Region Inc. Past Accepting new patients

Locations

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

8644 Sudley Rd
#220
Manassas, VA 20110

Interoperability endpoints

  • Direct secure messaging: carol.maxwell.1@14940.direct.athenahealth.com
  • Direct secure messaging: carolmaxwell@kysjhspe.allscriptsdirect.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1134538168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 NIDER BLVD STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234598701",
            "telephone_number": "757-953-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "CAROL",
        "middle_name": "ALLICIA ANN",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-04",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024182777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100348230 (KOHMG)",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.